| NPI | 1215105895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080S0010X Pediatrics, Sports Medicine (Licence: TN 49830) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 49830) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2024-01-17 |